EXAMINATION: Trump’s Health Initiative in Africa Faces Challenges

The United States has faced challenges regarding its America First Global Health Strategy, which was implemented in September 2025. Currently, twenty African nations along with four Latin American countries have entered into memoranda of understanding (MOUs) pertaining to this initiative. This strategy is intended to gradually reduce these nations’ reliance on non-governmental organizations (NGOs) for health support by establishing direct assistance from the US government for a duration of five years.

Previously, many African countries received health funding through the US Agency for International Development, but those aid streams have been halted by President Donald Trump, who also diminished the Presidential Emergency Fund for AIDS Relief. Much of the previous support was funneled through NGOs that the Trump administration accused of overly high operational costs.

Although the financial commitments from the US government are considerable, they reflect a notable decline of approximately 40 percent in the health financing these nations had received from the US government over the last five years. The countries involved are expected to begin self-financing their healthcare systems over the span of the five-year agreement, with potential future funding from the US being dependent on their compliance.

For instance, the agreement with Kenya entails an investment of about $1.63 billion from the US, accompanied by a pledge from Kenya to enhance its health budget by KES115 billion (approx. $890 million). In the case of Nigeria, the commitment rises to $2.1 billion, requiring Nigeria to contribute an additional $3 billion.

According to Secretary of State Marco Rubio, this strategy is expected to bolster security for the US, as enhanced health cooperation with foreign nations would facilitate early detection of disease outbreaks and enable proactive response measures before these issues could spread to the US.

For example, the MOU with Kenya is designed to empower the country to identify infectious disease outbreaks that could escalate to epidemics or pandemics within a week and to inform the US within a day of such findings.

Moreover, the initiative aims to provide American health firms with a competitive edge by sharing pathogen data, which they could utilize to develop vaccines and treatments ahead of others in the market. The objectives of these MOUs align with established goals of matching funding from donor countries, reducing reliance on external aid, and ultimately enabling nations to finance their own healthcare services independently.

Yet various African states argue that these agreements are unfairly exploitative. Zimbabwe’s MOU appears to have failed after the US withdrew due to concerns expressed by the Zimbabwean government. Zimbabwe was reportedly asked to share its biological resources and data without receiving any guarantees for access to health innovations that could derive from that information sharing, stated Nick Mangwana, the Secretary of Information, Publicity, and Broadcasting Services.

Additionally, legal challenges have arisen in Kenya, where its High Court has halted its MOU amidst two lawsuits concerning access to patient data and pathogens. Zambia has also voiced concerns regarding a proposed MOU, prompting requests for changes before any agreement is finalized.

According to Health Policy Watch, the MOU anticipated to be signed by Zambia failed to materialize due to US demands for access to the nation's minerals, particularly copper and cobalt. Similarly, health agreements with the Democratic Republic of the Congo and Guinea were contingent on signing agreements to allow US access to vital minerals, leading to legal disputes in the DRC.

As described by Zimbabwean representatives, the discussion surrounding these initiatives is likened to the mining of health data rather than merely valuable mineral resources.

Sophie Harman, a professor of International Politics at Queen Mary University of London, highlighted that the underlying principle of Trump’s America First global health policy involves extraction—seeking to enrich US companies rather than enhancing health globally, thereby using health issues as a lever against competitors like China.

Kerry Cullinan, the Deputy Editor at Health Policy Watch, has voiced that skipping over health NGOs could negatively impact vulnerable communities, given that many NGOs possess specialized knowledge and contacts. As she expressed, there seems to be a focus on rapidly obtaining information regarding infectious outbreaks, placing pressure on countries to allocate resources towards epidemiologists and laboratory technicians, while primary health needs may be better addressed by investing in nurses.

Cullinan reiterated that organizations like the WHO and Africa Centres for Disease Control and Prevention should ideally take the lead on such epidemiological functions.

Atilla Kisla, an expert in international justice at the Southern Africa Litigation Centre, remarked that Trump’s withdrawal from the WHO should not be interpreted as retreating but rather as a strategic geopolitical adjustment to leverage US power through the America First Global Health Strategy to navigate around the norms of health multilateralism.

Ultimately, African nations must acknowledge that the Trump administration's expectation of reciprocal benefits in exchange for health aid should not lead them to dismiss the strategy outright. They need to critically evaluate the available alternatives in a climate of declining international support for health initiatives. For instance, can Zimbabwe—a nation with limited financial resources—afford to overlook potential health assistance during these challenging times?